Monday, July 23, 2012

A Psychological Profile of James Holmes: The Joker Killer

In watching and reading the media coverage of The Batman movie killings in Aurora, Colorado, it is frequently stated that the killer’s behaviors are incomprehensible, not understandable, beyond belief, etc. Taken figuratively, I understand what these people are saying since there a very few people who would walk into a crowded movie theater, throw down chemical bombs, shoot and kill 12 people from ages 6 to 51, and wound 58 others. Taken literally, however, I disagree, because there are reasons why people behave the way that they do and those reasons are indeed discoverable.

The first thing I noticed about the alleged killer, James Holmes, that I have not seen anyone discuss yet, is that the school picture of him looks quite awkward. While clean-cut and properly dressed, what stands out from the picture is a vacant stare. Try staring at the picture and making a connection with it. You can’t. The smile also seems forced. In a video of him when he was age 18, note how when he speaks to the audience in front of him, he mostly looks at the presentation screen or at the floor, and when he does look in the audience’s direction, his eyes go out to right, preventing him from properly connecting with them.  He also never seems to directly turn and face the crowd in the clips shown.

The vacant stare, forced smile, and difficulty emotionally connecting with others is consistent with the repeated theme that has emerged in media reports from people who knew him (or knew of him) which is that he was shy, introverted, aloof, socially inept, stubborn, quiet, that he stayed to himself, and was easily forgotten.  This information, combined with other information below, makes me wonder if he has Asperger's syndrome, a condition manifested by qualitative impairment in social interaction and restricted repetitive and stereotyped patterns of behavior, interests and activities.

It seems that Holmes was teased, probably related to his social awkwardness, and that he did not know how to handle it and held his emotions in.  For example, a H.S. classmate said, "He was the kind of person that if you teased him, he would sit there and smile and really not do anything about it."

Many have remarked about his lack of on-line presence, at least under his real name. He apparently does not have a Facebook or Twitter account. Although he had a MySpace page, he either never had any friends or the friends were deleted due to an inactive account. Note how in his MySpace picture that both eyes are closed, apparently at a restaurant,which seems strange. He appears to have had more recent account with the website, Adult Friend Finders, and another profile with This indicates, given the other information that has come out about him, that he was having trouble finding a sexual partner using normal behavioral methods (e.g., introducing himself to someone, dating, etc) and was trying to bypass that by going directly to an exclusive sex dating site and swinger service. By this time, he had dyed his hair orange and was asking “Would you visit me in prison?” In a picture of him on he again seems awkward, with a strange smirk, one eye almost closed, and his head tilted to side. Maybe the sun was shining in his eyes, but all of the pictures seem odd for one reason or another.
Despite stellar grades, Holmes was unable to find a job. One wonders if it was due to his social awkwardness and extreme rigidity and stubbornness that caused him to perform terribly during a computer  programming summer internship. He had been giving off social cues, at least recently, that there was something seriously wrong with him. For example, it was recently discovered that he had a “bizarre, guttural, freakish” sounding answering machine message. It seem like he was struggling to fit into society and recently decided to withdraw from his PhD program. He was trying to pay for college by working part-time at McDonald’s, which obviously is not going to work. Some say he seemed depressed. He would not acknowledge people in his apartment complex who said hello. At some point,  it appears that he had enough. People who decided to shoot members of the public at random can get to that point by being convinced that the world (or a particular society) is the enemy and needs to experience retribution. To someone who thinks this way, there are no more individuals. Each person is simply viewed as a reflection of the society as a whole that the person despises.

In the case of James Holmes, such feelings may have been brewing for some time. It has been said that he always rooted for the bad guys to win and loved to play fantasy role playing computer games.  While there is nothing wrong with that, it seems that Holmes eventually had difficulty detatching fantasy from reality and eventually over-identified with the Joker character, most like Heath Ledger’s award winning version.  The Joker is known to take his anger out against the world through violent means, which sometimes involves using explosive devices and guns in public places. This may account for the dyed hair (although it is strange he did not dye it green) and would account for why he committed this crime during a Batman movie, identified himself as The Joker when police arrived, and is reportedly still carrying out the role in prison.

Note: The comments above are based on early media stories, are preliminary, and partly speculative. Also, I have never evaluated Mr. Holmes.

Related Stories: Cannibal Icepick Killer Luka Magnotta was Not Born Evil
                         A Psychological Profile of Chardon School Shooter, TJ Lane
                         A Psychological Profile of Wade Michael Page: The Sikh Shooter 

Sunday, July 15, 2012

Why I Contributed to New York's Psychology PAC

In advocating for psychology, a quote I have often passed on to colleagues is that “if you are not at the table then you will be on the menu.” This quote has been around since about 2000 as a Washington D.C. political saying. From a professional perspective, being on the menu in psychology is analogous to having something adverse occur to our profession on a state or national level resulting from a legal or regulatory action.

The more I become involved in professional advocacy/lobbying efforts, the more I have realized that being at the table is necessary but not sufficient to avoid being placed on the menu. You must also have strength when you are at the table.

There are four main ways to obtain this strength. One way is having a strong argument – but that is not enough. The strong argument has to deal with an issue that is publicly and politically beneficial for a politician or political appointee to support and ideally should have some type of emotional appeal. The second way is to have friends in powerful places – those who are closest to making the important decisions. An example of this that has nothing to do with psychology draws on my love of cinema. When Paramount chief Bob Evans was making the film “The Italian Job” he needed to film in Turin, Italy, and have the city shut down. He happened to know the most powerful man in the city who had the police and other government officials give Paramount everything they need to make the picture. Evans has remarked how that connection enabled him to do in one day what the President of the United States could not have done in one year.  The third way to obtain strength, at least with politicians, is by making a financial contribution to their political campaigns. This is how you maintain existing political friendships and make new ones.  Lastly, another way to gain strength at the table is to move yourself into a position where you play a major role in the important legal and regulatory decisions that are made.

In an ideal world, strength of argument alone would be enough to allow psychologists to obtain successful professional advocacy results. However, the real world simply does not work that way. We have already seen in New York where state regulators banned the use of psychology technicians and where legislators limited return to play decisions in concussion management to physicians only (thus no longer allowing psychologists with expertise in this area to perform this function). State regulators then followed this up by only naming school nurses as health care professionals who could perform cognitive testing in concussed athletes. Psychologists in New York were caught off guard in the former circumstance but were at the table for the latter. The problem is that we did not have enough strength at the table. Other professions did.

So, what can you do about it? One of the most important things you can do is to make a donation (however small) to PLANY, which is New York’s political action committee (PAC) for psychologists.  The PAC is expressly designed to allow special interest groups access to legislators so we can have a meaningful say in proposed legislation.  Politicians love donations from PACs because they do not need to spend any money soliciting the donation. The larger the PAC, the more influential it is. The PAC becomes larger and more influential with more donations. 

This is where YOU come in, if you are a psychologist reading this. For example, if you want the limited liability company laws (LLC) in New York State amended so that psychologists could be authorized to form LLC partnerships and corporations with physicians on a co-ownership basis, you should donate to PLANY to help get this done. This change is very important because it aligns what we know about best practices and would enable for the first time the creation of corporate partnerships between psychologists and physicians, putting psychology on an equal footing with medicine in our state. With health care reform here, this is something we cannot miss out on.

I want to challenge every psychologist reading this to donate to the psychology PAC in your state, even if it is a small amount.  Doing so would be a great way to help advocate for your profession. To donate to PLANY, please go to this link above for more information.

Thursday, July 12, 2012

The Medical History of Coca-Cola You Never Knew

Long before the modern day Coca-Cola beverage existed that billions of people drink around the world today, there existed a drink known as coca wine. Coca wine was sold in the 1800s alongside many other beverages at the time that contained cocaine. While this may sound shocking to some people today, back then, cocaine was a commonly used medicinal substance and it was not illegal.

For example, see the prior blog entry on the use of cocaine tooth drops.
Coca wine contained 30 grains of Erythroxylum coca per ounce of wine. Erythroxylum coca is one of two species of cultivated coca and is used to make cocaine (a stimulant drug). When wine is combined with cocaine, it creates a substance called cocaethylene. When ingested, it is almost as strong as cocaine.

Below are pictured two images of a coca wine bottle from Metcalf’s Coca Wine (click to enlarge).  As you can read from the back of the bottle, manufacturers of such drinks marketed them based on medical claims, leading consumer to believe that coca wine could cure just about any sign or symptom (i.e., “…a remedy for every malady…”). It was advertising as treating headaches,  anxiety, fatigue, depression, and fever, soothing  the vocal cords, aiding digestion, and more. However, these drinks were also used for pure pleasure seeking purposes.  It was specifically marketed to children, elderly, and people who were in a stage of healing, as you can see written on the back of the second bottle.

Metcalf’s coca wine was not the only one on the market (Vin Mariani was a famous brand in Europe), but it was one of the most popular. The manufacturers claimed that a medium dose of their wine produced a slow and sustained effect different from the excitation caused by any other wines. The dose? Three wineglasses a day! It is because of questionable medical claims such as these and the lack of dose modification for children versus and adults that stricter regulations over pharmaceutical substances later came to pass. It is interesting to note the marketers claiming a benefit of a slow and sustained release because it reminds me of the present day and age when drug companies market slowed release forms of stimulant medications (e.g., Ritalin) to treat children with attention deficit hyperactivity throughout the day.

Metcalf’s coca wine was run by Theodore Metcalf (1812-1894), a pharmacist who ran a widely known pharmaceutical business, selling products all over the world. His store was a mecca for famous people such as Charles Dickens and Oliver Wendell Holmes. Millions of prescriptions were filled by the company, written by some of the greatest physicians of the time. When Metcalf retired, he transferred the store to others. 

Eventually, John Pemberton of Atlanta, created his own version of coca wine, based on the Vin Mariani beverage. He called it Pemberton’s French wine, sold it in a pharmacy, and promoted it as a stimulator of the sexual organs. Once the Prohibition began in 1886, Pemberton replaced the wine in coca wine with sugar syrup and Coca-Cola was born. He marketed it as “the temperance drink” and once again, it is seen in the ad below that it was promoted as a cure for all nervous conditions even though this is obviously not true. Coca-Cola initially contained cocaine. Due to growing concerns about drug addiction in the U.S., cocaine was removed from Coca-Cola  in 1904 (except for trace amounts), but the cola leaf remained.  Now days, there is no cocaine in Coca-Cola at all. Cola wine no longer exists today in legal form but it led to a drink that almost everyone has tasted.

Reference: Mason, B. (1908). The Metcalf Pharmacy in Boston. Bulletin of Pharmacy.  I (XXII), 279-82.

Thursday, July 05, 2012

How New York Fumbled the Ball on Concussion Management

Below is a copy of a letter I sent today to Deputy Commission Ken Slentz at the Office of P-12 Education at the NY State Education Department (SED). The letter concerns opposition to aspects of the Concussion Management and Awareness Act.

The letter also addresses opposition to aspects of the concussion management regulations published by the State Education Department (SED) due to concerns that the safety and well-being of children are being put at risk, despite the best of intentions. The law excludes psychologists with expertise in concussion management and evaluations (e.g., neuropsychologists) from making return to play decisions in children who have suffered concussions. The subsequent regulations do not do enough to recognize the important role that neuropsychologists play in concussion evaluation and management.

If you are as concerned as I am about this issue, parents, students, health care professionals, and others should a) forward this letter to others, b) spread the word via social media and other media sources, and c) contact Senator Kemp Hannon, Assemblywoman Catherine Nolan, and those copied at the end of this letter to voice your opposition and advocate for the amendments to the law and regulations listed below.

Historical background:

Since 7/12/10, the New York State Association of Neuropsychology (NYSAN) and other state and national psychological/neuropsychological organizations have been in contact with multiple sponsors (i.e., Senators Hannon and Stachowski, Assemblypersons Nolan and Benedetto) regarding the Concussion Management and Awareness Act. Through these contacts, we advocated for reverting to the language in an earlier draft of the bill (S07572) that specifically allowed for “a licensed health care provider trained in the evaluation and management of concussions” to make decisions about return to competitive play and physical activity after a known or suspected concussion (mild traumatic brain injury). This would have allowed for our profession to continue in this role, which helps ensure the safety and well-being of children.

Despite our repeated advocacy and educational efforts, the bill states that only physicians are allowed to make return to play decisions after concussion, thus removing part of a psychologist’s scope of practice in New York and creating unnecessary health risks for children (see below). Ironically, the profession (i.e., neuropsychology) that has contributed the most research on understanding the effects of concussions, developed the cognitive assessment tools and symptom checklists now promoted by SED, and led the way in operationally defining a mild traumatic brain injury* is now not legally permitted to pull or return athletes from play in New York after suffering a known or suspected concussion. Meanwhile, physicians whose primary area of expertise is not directly related to neurological functioning (e.g., cardiologists and pulmonologists) are performing cognitive evaluations of such patients and provide return to play clearance.

NYSAN raised the above concerns with the Governor's Office before Governor Cuomo signing the bill into law but the office was non-responsive to our concerns. Senator Hannon (sponsor of the bill) informed me (and others) before the bill was passed that psychologists might be added through an amendment but after the law was passed it is our understanding that there are no such plans at this time. It was suggested to us through Senator Hannon’s and Assemblywoman Nolan’s office that psychologists could have a role in developing the regulations that were published by SED on the practical implementation of the law.

Opposition to Aspects of Current  SED Regulations:

Dr. Dominic Carone served as the New York State neuropsychology representative to SED (by their request) regarding the development of their concussion regulations, but the feedback and edits provided about adding neuropsychology more prominently in the document were essentially ignored and removed. The edits were not intended to change the law regarding who could provide return to play clearance (which we hoped to do with an amendment) but were designed to recognize the important role of neuropsychologists in concussion management and evaluations.

In the final version of the regulations, which were not released to us before they were finalized, new language was added stating that it is a role of school nurses to provide neurocognitive baseline evaluations and similar assessments with concussion patients to aide the physician in understanding the status of the child. This was the only profession specifically singled out to perform these evaluations. While a for-profit test company may provide a certificate to various health care professions to use such tests, this does not equate to the training and education on concussion management and evaluation provided through formal education and professional training in the neurosciences. The most qualified health care providers to provide this service are neuropsychologists due to their formal education and training in cognitive assessment, neurosciences (e.g., neuropathology, neuroanatomy), statistics, emotional pathology, symptom validity assessment, and other factors that are crucial towards interpreting test scores and patient presentations.

While NYSAN agrees with many aspects of the legislation and regulations, we believe that they unintentionally place children at risk of harm due to the problems noted above. As such, Dr. Carone requested that his name be removed as an advisor to these regulations and the request was granted. Neurocognitive evaluations can easily be misinterpreted by those who do not have formal expertise in this area, causing children to be cleared to return to play too early which risks further neurological injury. Another risk, which is rarely discussed in the media but often encountered in clinical circles, is withholding players from most physical activity and/or school for excessive periods of time, resulting in emotional pathology, declining academic performance, over-medication, and development of the sick role.

Action Points:

Our organization strongly recommends an amendment to the state law and regulations to be inclusive of our profession. Legally, this means broadening the language as we originally requested to be consistent with that of so many other states. In terms of regulations, this means specifically recognizing the important role of psychology/neuropsychology in the Concussion Management Team. Please note that neuropsychologists are included on the staff of NHL and NFL teams to aide in making return to play decisions after concussion. In addition, the National Athletic Trainers' Association recommends that a neuropsychologist should ideally be part of the sports-medicine team when evaluating players who have sustained a concussion (Guskiewicz, et al. 2004).Why would New York State not afford children that same layer of safety, protection, and expertise that are afforded to professional athletes?

I have copied Senator Hannon and Assemblywoman Nolan and request a personal meeting (separately or together) to discuss ways to move forwards on an amendment process. I will be happy to discuss this information further and my contact information is listed below.

*Note: Dr. Thomas Kay, a New York neuropsychologist, was the senior contributor of the American Congress of Rehabilitation Medicine’s operational definition of mild traumatic brain injury used throughout the world today. See the attached document for more contributions of neuropsychology. 

Reference: Guskiewicz, et al. (2004). National Athletic Trainers' Association Position Statement: Management of Sport-Related Concussion.  J. Athl Train. 39: 280-297

Dominic A. Carone, Ph.D., ABPP-CN
Diplomate, American Board of Clinical Neuropsychology
NYSAN Past-President

cc: Mr. Ken Slentz, Deputy Commissioner,Office of P-12 Education,NYS Education Department, 2M West EB,89 Washington Avenue,Albany, NY 12234
The Honorable Senator Kemp Hannon, The Capitol Room 420, Albany, NY 12247
The Honorable Assemblywoman Catherine Nolan, 836 Legislative Office Building, Albany, NY 12248
Doug Lentivech, Esq., Deputy Commissioner, Office of the Professions, New York State Education Department, 89 Washington Avenue, Albany, NY, 12234

Sunday, July 01, 2012

How Ripley's Believe It Or Not was Used by Big Tobacco

In the early 1980s, I used to love watching the Ripley’s Believe It or Not TV show with Jack Palance. There were and still are many Ripley’s Believe It or Not books, filled with all sorts of strange images, similar to these pictures on extreme human body parts. I also remember playing a Ripley’s Believe It or Not trivia game at the time, with the purpose being to tell whether or not what was stated on one of the cards was true or not. They also had questions like this on the TV show too.

Ripley began publishing brief panel articles in The New York Globe in 1918 featuring odd news and facts from around the world. In 1929, the famous publisher, William Randolph Hearst, began running these panels in his papers (syndicating them in 17 papers worldwide), increasing their exposure and popularity. In the 1930s, Ripley expanded into radio, short films, and opened a museum. In 1936, he was voted by New York Times readers as the most popular man in America.  As such, his endorsement was highly coveted by advertisers, including the tobacco industry.

Below (click to enlarge) you will see what is actually an advertisement for Old Gold cigarettes (established in 1926) designed to look like one of the Ripley panels. Old Gold is a cigarette brand of Lorillard Tobacco Company. Note their common advertising phrase at the time “Not a Cough In a Carload” features in the ad.

In the ad, the reader is informed about a “public test” of four cigarette brands in which Old Gold is reportedly chosen by otolaryngologists (ear, nose, and throat doctors or ENTs) as the best cigarette, leading to the eye catching headline.

Note that not a single one of the doctors are identifiable in the ad. The person in the dark suit is Ripley. Using ENT’s  was purposely designed to enhance the credibility of the sales pitch. After all, if cigarettes are believed to cause irritability to the nose and throat area, what better doctors to endorse a cigarette purporting not to cause such ill effects. Ripley claims to have run a blind experiment but unlike descriptions of true experiments, the reader is not told how many ENTs tried the cigarettes or what the cigarettes were that they were being compared against.

The ad also claims that there was a “decisive ratio” of 2 to 1 in favor of Old Gold but the reader has no idea if this is truly significant from a statistical perspective. Old Gold received 50% of the votes, two other brands received 25%, and another brand received no votes. To illustrate how misleading these percentages can be, if there were only four ENTs, and two picked Old Gold and one picked two other brands, then 50% liked Old Gold and 25% liked one of the other brands. But if there were only four ENTs in the test, the numbers are misleadingly inflated.

For those interested in learning more about how ENTs were used by the tobacco industry to cover up tobacco’s link to cancer, see this paper (the title says it all): The price paid: manipulation of otolaryngologists by the tobacco industry to obfuscate the emerging truth that smoking causes cancer. Believe it...or not.

Thursday, June 21, 2012

Does Second Impact Syndrome Exist?

It has often been reported that when a person suffers a second concussion (mild traumatic brain injury) before recovery from the first concussion takes place, that catastrophic brain swelling and death can result. This has been alleged to occur based on anecdotal information and when it happens (usually in young male athletes) it is referred to as “second impact syndrome” (SIS). SIS is often reported as a factual entity in the media and in the medical literature.

However, when one assess the evidence-based data for whether SIS truly exists, we are left with far more questions than answers. As Dr. Paul McCrory and colleagues (2012) put it, “The phenomenon of the second impact syndrome (SIS) continues to appear in the medical literature in spite of the lack of systemic evidence for its existence.” While McCrory's work is accessible through medical libraries, I have never seen in discussed in mainstream media coverage of SIS. Thus, a brief summary is presented below for ease of access for those who are interested.

Dr. McCrory has been studying SIS with evidence-based methods for over a decade. In fact, the seminal empirical study on this topic was performed by McCrory and Berkovic (1998). This was followed by a classic 2001 paper by McCrory entitled “Does Second Impact Syndrome Exist?,” which is the basis of the title of this blog entry.

In the 2001 paper, McCrory noted that 35 cases from the National Center for Catastrophic Sport Injury (NCCSI)  were cited as probable cases of SIS but not published in scientific journals due to lack of confirmatory details. McCrory referenced his 1998 study, in which he and Berkovic independently applied four basic criteria to 17 published SIS cases to determine how many would result in a diagnosis of definite SIS. Those criteria were as follows:

1) Medical review after a witnessed first impact.

2) Documentation of ongoing symptoms following the first impact up to the time of the second impact.

3) Witnessed second head impact with a subsequent rapid cerebral (brain) deterioration.

4) Neuropathological or neuroimaging evidence of cerebral swelling without significant intracranial hematoma (bleeding) or other cause for edema (swelling).

Not a single patient met all four criteria. Thus, there was not a single confirmed case of definite SIS in any of the cases reviewed despite the fact that all of them had been previously described or quoted as examples of SIS. Further analysis of the study revealed even more interesting details. For example, in 11 of 17 published cases, there was no evidence that a second impact actually occurred despite the fact that four of those cases had been heralded as “classic” examples of SIS in the literature. They also found that most of the evidence used to support a first impact was based on teammate recall (subjective evidence) rather than video tape (objective evidence).

Rather than merely accepting that the teammate recall was correct, McCrory and Berkovic performed a study of 102 football players to assess the reliability of their recall for concussive injuries sustained by their teammates. Their recall was compared to video-taped reviews and recall of the injured player. McCrory and Berkovic found that the teammates significantly over-reported the presence of initial impacts. In other words, they tended to report that a concussion occurred when objective evidence indicated otherwise. In only 11% of cases was there immediate medical documentation after the reported initial impact. Seventy-one percent of the cases were described as not meeting SIS criteria, whereas five of the 17 cases (29%) met three of the four criteria, with neither having a medical review after a witnessed first impact. These cases were described as probable (but not definite) SIS.

In McCrory’s 2001 article, he questioned why it is that SIS only tends to be reported in the United States despite the fact that similar or greater concussion rates occur in competitive sports throughout the world. To research this issue further, McCrory (who is from Australia) analyzed all deaths due to Australian football from 1968-1999. In these 32, there were 25 player deaths. Of these, nine were due to a neurological trauma and the others were due to non-neurological factors. Of the nine traumatic brain injury deaths, how many met criteria for SIS? None. No cases of SIS despite the fact that McCrory notes that the concussion risk in Australian football is about eight times that of American football. The risk of death from brain injury in this sample was 1 in 30 million player games. McCrory also questioned why there are not more cases of SIS in boxing compared to other sports due to the frequent concussive head trauma experienced in most fights.

McCrory also stated in his 2001 paper was that the published 1984 case by Saunders and Harbaugh that first used the term “second impact” to describe the death of a 19-year-old college football player actually did not have a described second impact. It is true that the wording used by Sanders and Harbuagh did not describe the second impact but it is also true that their wording does not preclude that some type of second impact to the head occurred. Specifically, all that they say about the second impact is as follows, “Despite accounts of no unusual head trauma, he walked from the field and collapsed.” The key word is “unusual.” This technically does not mean that no head trauma occurred but it means that there was no head trauma that anyone observed that was out of the ordinary. One could argue, however, that a head injury significant enough to cause a concussion would be considered unusual.
McCrory noted that belief in SIS has reached “almost mythical proportions” and that the term “second impact syndrome” is misleading. He suggested that SIS be replaced with the term “diffuse cerebral swelling” (a finding that was present in most of the cases he reviewed), and that this extremely rare condition is caused by a single brain injury (emphasis mine). I strongly agree with him. Another point I agree with him is the following conclusion from his 2001 paper:

“Most cases of traumatic cerebral swelling, whether associated with a structural brain injury or not, have no prior evidence of head injury with ongoing symptoms that would support the concept of second impact syndrome as defined in the literature. In those cases that are presumed to represent SIS, the evidence that a prior head injury is a risk factor for this pathophysiological entity is not compelling.”

One of the other points McCrory makes in his 2001 article relates to when the initial clinical presentation does not match the objective severity of the injury because of a gradual progressive decline as opposed to an immediate and rapid one. He noted that scientists have commented on this phenomenon dating back to 1891 and that the condition is now commonly referred to as “talk and die syndrome” because the person is initially conversant but then gradually and fatally deteriorates (or comes close to fatally deteriorating). He noted that this delayed response occurs in about 15% of all cases of “severe” head trauma and is caused by an intracranial hematoma (bleed) in 75% of those cases. Sometimes, the bleed is present when the patient’s brain is initially scanned but sometimes the bleed is not observable until after a delay.

It has been over 10 years since McCrory published his 2001 paper and so I contacted him to determine if his views on SIS had changed. McCrory’s response to me on August 11, 2010 was as follows and I am reporting it for the first time here (with permission):

“My conclusions on 'SIS' are unchanged. I have continued to track the literature and claims made on this topic and while I am happy to accept that perhaps someone may be able to satisfy the criteria (as per the original article) and really have the condition, I am yet to see it.  It is worth observing that the US is the only place on the planet where SIS is actually discussed as an entity. Most other countries have moved on from this viewpoint years ago.”

Yet, in the U.S., the most recent (June 2012) Guidelines for Concussion Management in the School Setting, published by the New York State Education Department (SED), states as a fact that "Additionally, children and adolescents are at increased risk of protracted recovery and severe, potential permanent disability (e.g. early dementia also known as chronic traumatic encephalopathy), or even death if they sustain another concussion before fully recovering from the first concussion."  It's a classic example of mythology prevailing over data. As a disclaimer, I served as a formal advisor to SED regarding this document and have asked to be removed due to statements such as these (and others that I strongly oppose) making their way into the final document despite presenting the data described above. There is not even mention of at least a controversy being present about this issue.

McCrory and colleagues (2012) and Randolph and Kirkwood (2009) point out that delayed cerebral swelling does not require multiple injuries to occur, is most likely caused by a genetic susceptibility, and is extremely rare. For example, Randolph and Kirkwood cited statistical data showing that the rarity of this outcome in 10 years of American football (1997-2006) was 1 in 1.8 million players. Despite this rarity, millions of dollars are being spent on baseline cognitive testing, largely with the hopes of preventing this outcome. People are scared by the media reports and schools do not want to be held liable. Hence, the need to want to “do something” and testing fits the bill. The problem is that the bill (using conservative estimates), according to Randolph and Kirkwood, amounts to 36 million dollars over 10 football seasons to try and prevent a 1 in 1.8 million person outcome.

McCrory and I agree that it makes sense to hold patients out of play after they have suffered a concussion (consistent with the 2009 Zurich consensus guidelines on return to play after concussion; which were authored by McCrory) because it reduces that chances of further injury to the brain and/or other parts of the body (due to slower reaction time) but not because it is going to reduce the risk of post-traumatic cerebral swelling. I also agree with Randolph and Kirkwood that the best way to manage patients who suffer head trauma during sports (and to try and reduce a catastrophic outcome) is via close observation to detect a neurological decline and to immediately initiate medical/neurosurgical intervention if such a change is detected.

Related articles:

 1. Junior Seau Did Not Suffer 1500 Concussions
 2. CTE and Suicide Link is Premature Speculation


McCrory PR, Berkovic SF. Second impact syndrome. Neurology; 1998;50(3):677-683.

McCrory P. Does second impact syndrome exist? Clinical Journal of Sport Medicine; 2001;11(3):144-149.

McCrory P, Meeuwisse W, Johnston K, et al. Consensus statement on concussion in sport - the Third International Conference on Concussion in Sport held in Zurich, 2008. Phys Sportsmed. 2009;37(2):141-159.

McCrory PR, Davis, G, Makdissi, M. Second Impact Syndrome or Cerebral Swelling after Sporting Head Injury. Current Sports Medicine Reports; 2012; 11(1),21-3.

Randolph, C. & Kirkwood, M. What are the real risks of sport-related concussion, and are they modifiable? Journal of the International Neuropsychological Society; 2009;15, 512–520 .

Saunders RL, Harbaugh RE. The second impact in catastrophic contact-sports head trauma. JAMA; 1984; 252(4):538-9.

Wednesday, June 20, 2012

Why You Need to Be Cautious When Shopping for Homeopathic Medications

I’m all for natural (homeopathic) treatment of health care problems if there is scientific evidence that it is effective.  As in the old days, people still rely on word of mouth recommendations from friends and family, casual review of non-scientific literature, and the advice of someone selling homeopathic products  to decide what medications to take to treat their ailments. These days, people have the added option of searching for such medication on the internet. No prescription is needed and the consumer proceeds at his/her own risk since the Food and Drug Administration does  not require that homeopathic medications undergo testing for safety and effectiveness.  

Many people are not aware of this and simply assume that since the medications are contained in a fancy looking bottle with scientific words, have stated indications for use, and/ or are sold on a website that looks legitimate, that they are safe and effective. While ineffective homeopathic medications may not directly cause harm, they can indirectly cause harm if the person fails substitutes an unproven treatment with a scientifically proven treatment. In some cases, this choice can mean the difference between life and death. A good example is How Fruits and Vegetables Killed Steve Jobs.

In perusing the internet tonight, I can across an advertisement for  oxydendrum arboreum (pictured above), also known as the sourwood or sorrel tree.  The ad states that it Is used for the following: “A remedy for dropsy - ascites and anasarca. Urine suppressed. Deranged portal circulation. Prostatic enlargement. Vesical calculi. Irritation of neck of bladder. Great difficulty of breathing. Tincture. Compare: Cerefolius (dropsy, Bright’s disease, cystitis).”

Let’s go through some of these terms. If you are not in the medical field, you may not realize that although this sounds fancy, that dropsy is an outdated term for edema or swelling. Ascities means fluid build-up in the space between layers that line the belly. Anasarca is extreme generalized edema. Suppression of urine output is obvious, as is difficulty breathing, prostate enlargement, and neck/bladder irritation. Vesical calculi is another terms for a bladder stone. Tincture refers to an herbal tincture, which is an alcoholic extraction of plant material by combining it with a liquid, typically alcohol. In other words, the medication is available in liquid form. It was also available in tablet form. On the last line, the ad compares the medication to another homeopathic treatment (Cerefolius) used to treat dropsy, cystitis (bladder inflammation), and Bright’s disease. Bright’s disease is an obsolete term used to describe acute or chronic kidney inflammation.

The use of obsolete words such as dropsy and Bright’s disease on a modern medical ad made me suspicious, so I did some more research and found this old advertisement from 1908:

Lo and behold what do we see?  Terms such as Bright’s disease, dropsical effusions (a reference to dropsy), anasarca, ascites, and edema as conditions that can be treated by a medication known as oxydendrine. Oxydendrine’s first ingredient is listed as oxydendrum, the plant being sold above on the internet today. Oxydendrine was the trade name for a medication that combined oxydendrum with other plant treatments including iris, sambucus,  and scilla (squill).  In 1908, it was being recommended that when used to treat dropsy due to heart disease, that the medication be taken with each meal and at bed time. For most people that is four times a day, which is a lot of pills. In fact, in severe cases, up to 8 pills a day were suggested. More pills equals more money. 

It does not seem that Oxydendrine was around long based on my own research into the topic, although I am happy to be provided any information to the contrary on that.  I can confirm that it was in use between 1907 and 1908. There is no scientific literature available in PubMed (repository of peer reviewed scientific research studies) that support the use of Oxydendrine or the primary ingredient, oxydendrum, for any medical treatments.  It seems like it was yet another type of patent medication such as Pink Pills for Pale People, which purported to treat various ailments without proof of safety or effectiveness.

 It also seems that information about Oxydendrine was taken from medical ads from over 100 years ago and used as the basis for a modern ad for a homeopathic treatment on the internet. While oxydendrum may indeed have some unknown medical properties, buyers beware when purchasing this substance or others that you have not properly vetted scientifically. If you need suggestions on how to do that, see my Five Ways for Evaluating Suspicious Medical Treatment Claims.

Thursday, June 14, 2012

Cannibal Icepick Killer Luka Magnotta was Not Born Evil

While I may be wrong, I have never bought into the notion that people are born evil. It seems like a far too simplistic explanation and can serve as a way to conveniently ignore the ways in which negative life experiences (e.g., abuse, neglect, and poor parenting) combined with a lack of positive coping resources and other factors, can lead to depression, anxiety, low self-esteem, building to anger, rage, revenge fantasies, and abusive tendencies. For sure, people are born with biological temperament, but this temperament interacts with life experiences to shape who we are as individuals.

This brings me to the disturbing case of Luka Rocco Magnotta, who was widely known for videos he posted on Youtube involving the torturing and killing of kittens, followed by bestiality. More recently, he has recently been arrested for videotaping himself murdering a college student, Jun Lin, with an icepick, dismembering him, cannibalizing the corpse, engaging in sexual acts with it, posting the video on the internet, and mailing the body parts throughout Canada. Was he really born to do this? Nothing could have stopped it? He could have had no other type of life? I’m not buying it.

While new information is emerging daily, we know that Magnotta was born as Eric Clinton Kirk Newman on 7/24/82 in Scarborough, Ontario, to Don Newman and Anna Yourkin. At some point in childhood, it is known that he went to live with his grandmother in Lindsay, Ontario. While I have never met him, and I am not trained in psychological profiling, as a psychologist, my informal perspective on the matter is that the following played key roles in leading to where we are today. This perspective is based on media reports and is contingent upon the accuracy of the information in those reports.

1. Traumatic childhood: While details from his early childhood are very hard to come by, it has been reported (by one of his own family members) that his family life was very dysfunctional. His parents did not remain together. Based on comments he has made on the internet, he described a “horrible” childhood and did not feel loved by his family. He has been said to report on the internet that he had been sexually abused multiple times. Whether that is true or not is unknown at this time, but I am inclined to believe it given what we know about his sexually abusive behavior. While everyone responds to abuse differently,  some people hold in significant anger and seek ways to reverse roles, regain a sense of lost power,  and become the abuser against a helpless victim. This was popularized on the popular TV show, The Shield, when police captain David Aceveda responded to male rape by being abusive to women and eventually having the offender killed. As described in a prior blog post, animal abuse is often the precipitant to human abuse, and Magnotta engaged in numerous such actions against kittens and possibly other animals as well.

2. Not feeling loved: There are many victims of child abuse who go on to live successful and productive lives, which is aided by having a positive support system in place. For Magnotta, however, that does not appear to be the case. His father was reportedly not a significant presence in his life (he claims not to have even known him), his mother does not appear to have been around him much (and when she was they reportedly did not get along), and he was reportedly raised by a domineering grandmother. So now we have alleged abuse combined with what appears to be a lack of emotional support and further experiences of being under aversive control. Not a good combination. His grandmother has been described “…as a domineering personality who would beat up people with submissive personalities and get them to do what she wants.”  He was been quoted as saying about himself on the internet that “All he wanted was love.”

3.  Low self-esteem and narcissism:  A past filled with trauma and emotional neglect can easily lead to low self-esteem. One maladaptive defense mechanism for this is the development of narcissistic personality disorder, the essential features of which is a pervasive pattern of grandiosity, need for admiration, and lack of empathy that begins by early adulthood and is present in a variety of contexts. An ex-girlfriend described him as emotionally cold. He clearly was obsessed with his self-image, which he admitted during an audition for a plastic surgery show. He posted a large volume of model shots of himself online (just do a Google Image search to see this) which often show him in provocative poses,  fancy cars, and prominently worn designer clothes, all of which are designed to convey self-importance. He had more than 70 Facebook accounts about himself whereas the average person has one. He is known to have created numerous fake usernames on internet message boards in which he wrote about himself, spread rumors to create an additional sense of self-importance, and then denied them to draw further attention to himself. Despite all of his attempts at success, he was a continued failure, including his botched attempts to become a porn star and reality TV show contestant. These failures may have fueled his rage against society. Ironically, as police predicted, his narcissism led to his arrest when he was found in an internet cafe reading stories about himself.

4. Immersion in fantasy life:  While most people are able to differentiate fantasy from reality, some people become obsessed with fictional characters or develop fantasy relationships with non-fictional individuals. For example, he was known to be obsessed with James Dean, the famous actor best known for portraying a troubled teen with a dysfunctional family defying society in Rebel Without a Cause. Dean and Magnotta bear somewhat of a physical resemblance, which helps make the fantasy immersion more real. He became obsessed with plastic surgery, partly to help him look more like Dean, and he was known to pose like Dean in various photos. He spread rumors that he dated Karla Homolka, a famous Candia murderer who videotaped rape and murders she was involved with. He was known to use the name, Kirk Tramell, as an alias, a likely take on Catherine Tramell in the movie, Basic Instinct, who kills a lover with an icepick. His name change to Luka Rocco Magnotta on 8/12/06 reflects a combination of low self-esteem (not liking his original identity) and appears to reflect his latching on to fantasy characters. It is widely believed that he chose the name Magnotta after the character Vince Magnotta from a video game called Ripper. The character is a serial killer who butchers his victims. It is unclear where his cannibalistic urges came from but cannibal themes are actually quite prevalent in fiction and non-fiction, that he likely glommed on to one or more of these characters/individuals as a morbid curiosity.

In conclusion, I do not believe that Luka Magnotta was born evil. He may have been born with a negative temperament, but his crimes were shaped by negative events in his life, a lack of pro-social coping resources, an increasing sense of alienation, emotional pathology, revenge and power fantasies, immersion in fantasy life, and an obsession to draw attention to himself. Lastly, this article should not be taken as excusing his criminal actions, but as a way to explain his behaviors from a psychological perspective. For the record, I find his behaviors reprehensible, abhorrent, and believe he should be prosecuted and punished to the fullest extent of the law.

Related blog entries:
A Psychological profile of Wade Michael Page: The Sikh Shooter
A Psychological Profile of James Holmes: The Joker Killer
A Psychological Profile of Chardon School Shooter, T.J. Lane

Saturday, June 02, 2012

Stopping Pet Abuse Helps Stop Cannibal Killers and Other Violent Criminals

There is a very good reason why society should have zero tolerance for the abuse of animals and children: because they are the essence of innocence, uncorrupted by society. However, the innocence that most of society cherishes in animals and children is exactly what makes them so alluring to sociopaths. They enjoy the power they have over a life that is defenseless and enjoy using that power to corrupt it. Animal abuse can involve killing, torturing, neglect and/or defiling the body of animal.

For many people who go on to commit unspeakable crimes against humans, non-human animals usually serve as the first targets. There are many examples of this. Jeffrey Dahmer, who became a human cannibal as an adult and experimented on his victims, dissected dead animals and impaled a dog’s head on a stake. Alleged murderer, Luka Rocco Magnotta, who allegedly stabbed a man repeatedly with an ice pick, dismembered him, and ate part of his body, began his criminal acts with animals, feeding a kitten to a python and also killing two kittens by placing them in a plastic bag, sucking the air out with a vacuum, dismembering them, and performing sexual acts with their body parts.

I can go on and on with many other revolting examples, but the two examples above make the point. While very difficult to hear and even write about, society needs to make the capture, prosecution, and sentencing of animal abusers a much higher priority. For example, it is amazing to me that Magnotta was never arrested by law enforcement for his kitten murders despite widespread outrage by many on the internet to identify and stop him. If he had been arrested and prosecuted for kitten murders, then the person he killed would probably still be alive today provided a meaningful sentence was implemented. 

Fortunately, most states have felony provisions for animal abuse, but it is unacceptable that three do not: Idaho, North Dakota, and South Dakota. Across all states, the average maximum jail time for animal abuse is 47.2 months (about 4 years). The states that take this issue the most seriously are Alabama and Louisiana (10 year maximum sentences) and the state with the shortest sentence is North Carolina (6 months maximum sentence). The average fine for animal abuse across the U.S. is $24,420. However, that average is significantly skewed by Colorado imposing a maximum fine at $500,000, followed by Arizona at $150,000 and Oregon at $100,000. The fines from most states are actually $5,000 or less. The lowest maximum fine is $1,000, which occurs in North Carolina, Arkansas, Rhode Island, and South Dakota. One state (Tennessee) does not appear to have a fine.

Only 14 states have laws that allow for a temporary or permanent ban on animal ownership as part of sentencing. That means 36 do not. Only 7 states have laws that allow allows for animals to be included in protective orders (known as pet protective orders). That means 43 do not. Thirty-two states include mandated counseling for animal abusers. That means 28 do not.

There are a few things worth noting from the existing penalties for animal abuse, which is courtesy of First, in many states, it costs more to purchase a pure breed animal than it costs to torture and kill it. That should never be the case and should be changed. Second, all states should have mandated counseling for animal abusers, allow for a permanent ban on pet ownership (after you abuse a pet you should not get a second chance), and should allow for pet protective orders. Third, the states of South Dakota and North Carolina appear to take animal abuse the least seriously since the former does not include animal abuse as a felony and has one of the lowest fines while the latter has the shortest maximum jail sentences and one of the lowest fines.

Of course, people need to use common sense when it comes to what constitutes a crime in the death of animals, since there are people who have licenses to hunt and fish, companies that slaughter animals for food, and who among us has not swatted a fly in the house to prevent the spread of germs? All of these instances, however, are vastly different from somebody who kills an animal for the express purposes of gaining pleasure from watching it suffer and/or die. These are the people who need to be identified, prosecuted, and stopped, not only in the pursuit of justice, but also to prevent hard to human beings.

Children need to be taught from early on to respect life and to follow the Golden Rule. This means no killing of animals, including insects, purely for pleasure or entertainment. This teaches empathy, which is something lacking in many people who go on to become violent criminals.

If you want to see just how common animal abuse is, just do a zipcode search in the national searchable database at to see the shocking results near you. Those very people may go on to abduct and kill one of your family members or someone in your community. Visit to find out more about how you can help. 

Friday, June 01, 2012

Why All of the Recent Human Cannibalism?

Warning: This blog entry contains information that is graphic and disturbing. Do not read further if you are not so inclined. Ta Ta.

It began on Saturday, 5/26/12. The nation was shocked to hear that 31-year-old Rudy Eugene, a resident of Ft. Lauderdale, ran naked down the Miami Causeway, came across a 65-year-old homeless man (Ronald Poppo) lying innocently in the shade, pummeled him in broad daylight, and devoured most of his face.

I had actually recently posted a blog entry about my personal observation of an obese, naked, mentally ill man rolling around Ft. Lauderdale Beach for years, but the Rudy Eugene story was something well beyond that. There are news reports that Eugene had a history of aggression, paranoia, religious pre-occupation, and poverty. Given his age, it is possible that he may have had a mental illness such as schizophrenia, but even if this is true, cannibalism is not common in schizophrenia. It is unclear if Eugene was intoxicated at the time and there has been much speculation that he showed tell-tale signs of delirium and aggression on that day due to ingestion of bath salt stimulants that he may have ingested at a Miami concert the night before.

Then on 5/30/11, it was revealed that a 29-year-old gay porn actor named Luka Rocco Magnotta (real name Eric Clinton Newman), who was known for killing kittens and posting the videos online, shipped human body parts (i.e., foot, hand) to political parties in Canada. I joked that night that I was scared to see what tomorrow’s news will bring. Indeed, on 5/31/12, it was revealed that Magnotta videotaped himself killing the victim, eating parts of him, and then releasing the video on the internet. This was after his animal abuse exploits went unaccounted for. And if that wasn’t enough, a 21-year-old Maryland college student named Alexander Kinyua was arrested the same day for killing his 37-year-old housemate, cutting him up, eating his heart, and part of his brains.

That’s three human cannibal stories in less than one week, which is extremely bizarre.
As a scientist who studies the causes of human behavior, I wanted an explanation as to why this was happening and why someone would ever decide to eat another human besides starvation in extreme conditions. Below is a basic summary of what I have found, thought about, and hypothesized, to understand this issue more but I welcome your comments as well because I sure do not have all the answers.

To begin with, the word cannibal comes from the fact that Christopher Columbus wrote about ferocious people from the Carribean islands and parts of South America, known as the Caniba, who ate people. Some anthropologists believe that cannibalism was very common in pre-historic times. There is even a story of cannibalism in the Bible (2 Kings: 25-30). As a neuropsychologist, I am also familiar with the incurable neurodegenerative prion disease known as kuru, which was transmitted when members of the Fore tribe of Papua New Guinea consumed the dead.

There have been many stories throughout history of cannibalism due to necessity from famine. Many may be surprised to know that this happened among U.S. colonists, who dug up corpses for food. One colonist even killed, salted, and ate his pregnant wife. Many are more familiar with the cannibalism among the Donner party, a U.S. settlement group in the mid-1800s. Cannibalism occurred all over the world, such as in Nazi concentration camps, Japanese troops in WWII, China and North Korea (due to famine), and many others. 

Then there are cannibal stories popularized in our culture, such as the hag in Hansel and Gretel who tries to cook and eat little children. We are told of Count Dracula, who didn’t actually eat people, but bit their necks and sucked their blood. The Dracula craze has never died off and is popularized in modern times by the Twilight book and movie series. Zombies have also been very popular as popularized the Living Dead series and their quest for eating human flesh. Then there is the story of Leatherface, in the Texas Chainsaw Massacre, who was a cannibal living amongst a family of cannibals. Leatherface took things one step further and wore the skin of his victims. Perhaps the most famous modern fictional cannibal is Hannibal Lecter, who was famous for eating his victim’s faces (sound familiar?).

Many people perform a very limited form of self-cannibalism, such as biting their fingernails and toenails and eating them although some dispute that this is true self-cannibalism. Some people eat their own skin after it has peeled off from a bad sunburn. Some people also eat their own hair, which is known as trichophagia. Some people eat their own scabs. Some animals (e.g. goats) are known to engage in self-cannibalism as well such as eating the placenta of their young but this is for nutritional benefit. The short-tailed cricket is known to eat its own wings. The North American rat snake has been known to try to consume its own body.

Back to humans, most people all familiar with the cannibalistic crimes of Jeffrey Dahmer. One of the most disturbing cases is that of Albert Fish, who cannibalized young children and tormented parents by sending them notes vividly describing his crimes. Andrein Chikatilo used cannibalism as a way to gratify his sexual needs, in an extreme extension of Count Dracula. Just a few years ago (2008), Tim McLean was savagely decapitated on a Greyhound bus by 40-year-old Vince Weiguang Li, who then proceeded to eat parts of the body.

This year, a German researcher (Hamalainen, 2012) reported the first case of a non-human primate (gray mouse lemur) cannibalizing an adult member of the same species. The body cavity was torn open and the inner organs eaten. The skull had been broken and the brains were consumed. The spinal cord was being devoured as well. It is unknown if the cannibal lemur had killed its victim or if it was scavenging. The authors concluded that “Cannibalism may confer immediate nutritional and energetic benefits to the cannibal and therefore might have adaptive value at the individual level.” Previously, non-human primates had only been known to cannibalize the young. Some insects (e.g., praying mantis), fish, amphibians, and birds have been known to cannibalize adults members of the same species.

Overall, if you think about it, cannibalism has been practiced all over the world and throughout history, sometimes due to famine, sometimes due to crime, and sometimes due to mental illness. It occurs in humans, insects, and various other non-human animals including primates. It is popularized in our culture through scary stories told to children and horror movies designed to scare adults. It is also relatively common for people to eat parts of their own skin (e.g., nails, hair, peeled skin) and scabs. My theory is that what  happened in the Rudy Eugene case is that someone with a probable prior mental illnesses and/or certain form of drug intoxication caused him to become disinhibited and regress to a very primitive evolutionary state. Whether this is what happened in the other two cases is less clear given that not enough information available. Why there have been three cases in less than one week is also unclear but one has to wonder if there is a copycat crime element to this in some people who are already seriously mentally ill.


Hamalainen, A. (2012). A Case of Adult Cannibalism in the Gray Mouse Lemur, Microcebus murinus. American Journal of Primatology 00:1–5 (2012).
Wikipedia cannibalism page
Wikipedia self-cannibalism page

Wednesday, May 30, 2012

Pink Pills for Pale People

In my ongoing documentation of medical claims and treatments that are overly promoted despite not having scientific evidence to support that they work as advertised, today’s blog entry turns its focus on Dr. Williams’ Pink Pills for Pale People. As you can see from the ad below (click to enlarge), this medication was not only said to improve pale complexion, but that it could also cure all nervous diseases, all female weaknesses, all diseases arising from mental worry, over-work, excess, early decay, etc., among many other conditions. Whenever any medical treatments claim to cure all of anything, it is a huge red flag that someone is over-promoting a product.

Other advertisements would describe someone (sometimes a child for maximal emotional impact) suffering from a severe medical condition who could not be saved by any other treatment except for these particular pills. Many advertisements contained the endorsement of a Reverend Enoch Hill, who claimed that the pills cured his headaches and gave him energy. The use of a holy man was not an accident because many people believed that such a person would not lie. Any testimonials or claims of miraculous recoveries were relied on heavily for advertising. Another trick that was used in the marketing was to create advertisements that were difficult to distinguish from genuine news articles.

In 1890, a Canadian physician, Dr. William Jackson, sold a Canadian businessman and politician named George Taylor Fulford the rights to Dr. Williams’ Pink Pills for Pale People. The Name “Pink Pills for Pale People” was merely a marketing technique used to draw attention to the product (by having four words start with the letter “P”). The rights were sold for $53.01 and would make Fulford a millionaire.

Also in 1890, John Mackenzie, a successful Canadian business man with journalism experience began to work for Fulford and helped publicize the pink pills. Beginning in 1900, the medication was sold by Dr. Williams Medicine Company, which was part of G. T. Fulford & Company. The latter was a company created by Fulford in 1887 to manufacture and distribute similar medications with extensive claims yet little to no evidence to back them up. Despite the lack of scientific evidence, Pink Pills for Pale People became very popular due to what it was claimed to accomplish and was sold in over 80 countries.

In reality, the main ingredient in Pink Pills for Pale People was iron. While the pills could have made some people with anemia feel better due to the iron content, they were much more expensive and did not contain as much iron as the regular iron pills prescribed by physicians. These pills did not require a prescription from a physician as they could be purchased from a pharmacist much like an over the counter medication is purchased today.

As you have probably figured out, Pink Pills for Pale People were not the cure-all they were claimed to be in public advertising. Ironically, only when someone bought the pills and received the official instructions did it say that the pills were not a cure-all (despite still saying in the instructions that the pills cured all conditions in numerous categories). Of course, the instructions say the only way a cure can be obtained is by taking more and more of the medication. One of my favorite sets of instructions had to do with men, which said that in order for the pills to work they needed to avoid lascivious thoughts, conversation, and books, “live a pure and manly life,” and follow many other directives. If one followed all of the instructions, it was said that a cure was sure to follow.

The reason that medications such as these and many other sham medications and treatments today have been successful for a time was because they offered hope for people in hopeless situations. Unfortunately, there will always be many people in such situations, which is why there will continue to be victims of these money-making schemes. Pink Pales for People, however, are no longer sold today. 

Thursday, May 24, 2012

Lucky Strike, Marlene Dietrich, and Suspicious Scientific Claims

If you read my article entitled Five Ways to Evaluate Suspicious Medical Claims, you will see that Step 1 is to search the peer-reviewed medical literature. These days, it is easy to do, with online tools such as PubMed. Decades ago, however, it was not so easy and consumers largely had to rely on the honesty of the company making the claim, which is always a risky proposition because the company has a conflict of interest. A good example is this Lucky Strike cigarette ad in 1950 from actress and singer, Marlene Dietrich (click to enlarge).

Note how the ad days “Scientific tests prove Lucky Strike milder than any other principal brand!” What scientific test? Oh, the one confirmed by an “independent consulting laboratory.” While this ad was used decades ago, similar advertising techniques are still used today. So, if you see claims such as this, here are a few reasons to be skeptical:

1)    It’s a sales ad.
2)    There is no citation for the scientific research study in the advertisement (current scientific literature search shows no published scientific research on whether Lucky Strikes are truly milder).
3)    The supposed independent research lab is not named.
4)    Think creatively about how words can be played with. For example, the company owning Lucky Strike (American Tobacco) could have easily hired an independent consulting company (they don’t work for free) and paid them to “independently” confirm their research interpretations. After all, it does not technically say that the consulting lab ran its own tests. It only says that scientific tests were confirmed by the independent lab. The way the sentence is written leads you with the impression that separate studies were done. But, for all we know, American Tobacco just sent them their own lab results, had them look it over, and paid them to say that their claims were true without actually doing separate research studies.

The other thing to keep in mind, related to point #1, is that American Tobacco, the company that owned Lucky Strike was paying actors and actress huge sums of money for these types of endorsements, particularly for Lucky Strikes. The relationship was mutually beneficial. While American Tobacco benefited from a Hollywood endorsement, cigarette smoking was an essential part of Dietrich’s screen image.

Wednesday, May 23, 2012

Did You Know that Bayer Marketted & Sold Heroin?

While everyone reading this likely associates the name Bayer with aspirin, most people will be shocked to know that Bayer actually independently created, marketed, and sold heroin (as shown in the bottle above). That’s right…heroin, the highly addictive drug that is now illegal throughout the world. Below is the story of how this came to be and why it was stopped.

To take a step back, heroin was originally invented in 1874 by C.R. Alder Wright, an English chemist and physics researcher. When I say invented, that is because heroin does not occur naturally (unlike, say, marijuana) but needs to be synthesized. It is derived from combining morphine (a strong pain relieving substance) from the poppy plant with two acetyl groups (combinations of methane, carbon, and oxygen). This is why heroin is also known as diacetylmorphine. Wright was trying to a non-addictive alternative to morphine, which was frequently abused at the time and had undesirable side effects. 

In 1897, a chemist (Felix Hoffman) working at Bayer independently re-synthesized heroin under the supervision of his boss, Heinrich Dreser, who was the head of Bayer drug development. They were actually trying to produce codeine but heroin was the result. Still, the end result that is heroin has proven to be just as potent. Dreser tried it on himself and staff and enjoyed the effects it produced. In developing a marketing campaign, Bayer realized that calling it diacetylmorphine was not going to work. They needed a marketing name (trade name) and decided to call it Heroin. That’s right, Bayer came up with the name Heroin. It was so named because it had heroic effects on the user.

Bayer decided to market heroin it as a morphine substitute (to cure addictions to morphine) and cough suppressant (as you can see on the ad above, click to enlarge) from 1898 to 1910. Cough suppressants were important back then due to the problems caused by tuberculosis and pneumonia. Free samples were sent to thousands of doctors and by 1899 Bayer produced a ton of heroin a year (literally) and exported it to 23 countries. Back in those days, heroin was widely accepted as a legitimate medicinal drug, forms of it were available in drug stores, and the American Medical Association approved it in 1906 or 1907.

Despite Bayer’s hopes, it turned out that heroin was highly addictive, up to 4 times stronger than morphine, and rapidly metabolized into morphine once it crossed the blood-brain barrier. Basically, in trying to create an alternative to morphine that was less addictive, they created a faster acting version or morphine that was more addicting and caused rapid onset euphoria. Ooops. There began to be a very high demand for heroin by patients even though they were not in respiratory distress. A new group of addicts was created and numerous hospitalizations resulted. It was a historic embarrassment for Bayer and they ceased production of heroin in 1913 and removed it from their official company history. In case you were curious, the U.S. banned the manufacturing, sale, and importation of heroin in 1924.

Saturday, May 19, 2012

A 39-Year Obesity Treatment Fraud

In 1900, the curious little advertisement below appeared in Cosmopolitan magazine that was addressed “To Fat People” (click to enlarge).

If you read my article entitled Five Ways to Evaluate Suspicious Medical Claims, you will see that this ad definitely met the criteria of seeming too good to be true. For example, losing 2 to 8 pounds a week without any radical change in what you eat and without any significant side effects?  You will also see that the weight loss treatment is pitched by someone who claims expertise in causing weight loss, a Dr. H.C. Bradford. He made the extreme guarantee that you will never feel better in your life if you try his treatment. In addition to weight loss, he claimed that problems in organs such as the heart, kidney, and stomach will be remedied. All you have to do is send away for a booklet.

As you can below (click to enlarge), these ads would continue and become even more dramatic, with pictures of “Fat People” who appeared sad and ashamed of themselves or of a thin woman who appeared the desired weight advertised “To Fleshy People.” It was a direct appeal to the emotions and struggles of people with obesity, to compel them to write in for the booklet and get them hooked. The ads below say much of the same as the original Cosmopolitan ad but add that the five-week system is perfected and based on scientific principles and common sense. Really? Even though you can “eat as much and as often as you please.” The claims came down to a 3 to 5 pound of weight loss per week. Another claim was that all patients would receive careful and personal attention whether treated by mail of in person. The name of the place to send information to even sounds pretty legitimate…The United States Medical Dispensary.

Curious, I decided to investigate further. All attempts to find out anything about the “United Stated Medical Dispensary” came up empty, which indicates to me that it was likely just a made up fancy-sounding name to impress potential customers. So then I turned my attention to Dr. H.C. Bradford. At first, all I could find were references to his advertising and nothing about the man. In fact, I have yet to find a copy of his pamphlet that he sent out to patients. If anyone has a copy (or can tell me more about H.C. Bradford), please let me know.

Finally, after continued research, I was able to locate an article from the Journal of the American Medical Association that shed light on the entire scam. The article is called “Bureau of Investigations: Bradford, Brough, Doyle, and Davis: Various Doctors Connected with Promotion of Obesity Cure.” You can read the entire article here, but if you do not care to, here is the summary.

As it turns out, H.Clark Bradford passed away in 1915 and his business was taken over by Dr. F. Thompson Brough. However, the technique sold was still referred to as The Bradford Method. Brough had already been known in the medical community as a quack. He committed suicide in 1930. The business was carried on by a Dr. Frank J. Doyle. After he died in 1939, the business was carried on by Dr. William A. Davis.

Bradford, Brough, and his successors had been selling patients pills with ingredients (e.g., baking soda, oil of peppermint, powdered rhubarb) that had nothing at all to do with weight reduction, were not scientifically proven, and actually could lead to harmful results. While the company claimed that no chemical preparations were used in their pills lab tests showed this was not true.

The Bradford Method was primarily a mail order business and the Post Office and American Medical Association began to investigate it due to concerns of mail fraud. The company continued to claim the specialized medical expertise was being brought to bear to treat obese patients but investigations found that Drs. Doyle and Davis had no such experience. Expert medical testimony showed that these doctors did not have enough information about their patients to prescribed safe, sure, or permanent obesity cures. It was found that The Bradford Method could actually lead to fatal reactions if certain other medical comorbidities were present.

Treatment was actually not individualized to the patient since all patients received the same medications for the first five weeks. Also, five weeks was just the beginning of a process that lured people into 45 weeks of medication use, massage lotion application, and exercises. Medical testimony showed that claims that patients would not be left with wrinkles, flabbiness, or other undesirable residuals were false as was the claim that the treatment with cure problems in the other organ systems. In fact, the ingredients in the pills were known to significantly irritate the gastrointestinal tract. The exercises prescribed were potentially dangerous in certain cases, yet this did not stop them from trying to sell the product to pregnant women.

When questioned under oath. Dr. David admitted he did not know much about metabolism and did not even know the basis used to determine a calorie. He claimed to be an expert on medications but could not answer basic some basic medication questions asked of him. He was forced to admit that many of the claims made in the advertisements were untrue. On 12/1/39, a fraud order was issued against the company, banning them from further use of the mail. And thankfully, that was the end of that, but many fraudulent medical claims and activities persist to this day which people need to be continuously on the look out for.